Combo TX Surpasses Fluoxetine or Therapy Alone, TADS Results Show

Combo TX Surpasses Fluoxetine or Therapy Alone, TADS Results Show

Article excerpt

TORONTO -- Fluoxetine combined with cognitive-behavioral therapy was more effective in improving functioning, global health, and quality of life in depressed adolescents than was either treatment alone, Dr. Benedetto Vitiello said at the joint annual meeting of the American Academy of Child and Adolescent Psychiatry and the Canadian Academy of Child and Adolescent Psychiatry.

However, he noted, although symptoms of depression might have improved, many patients remained functionally impaired after 12 weeks of treatment, even with the most effective therapy. "It's not really surprising that function doesn't improve as quickly as symptoms," he said in an interview. "You would expect symptoms to improve first, and then to see a gradual improvement in function."

Dr. Vitiello, chief of the child and adolescent treatment and preventive intervention research branch of the National Institute of Mental Health, presented a secondary analysis of the Treatment for Adolescents with Depression Study (TADS). The TADS trial included 439 patients aged 12-17 years with major depressive disorder. Patients were randomized to either 12 weeks of fluoxetine alone (10-40 mg/day), cognitive-behavioral therapy (CBT) alone, CBT with fluoxetine (10-40 mg/day), or placebo.

The study found that combination therapy reduced the symptoms of depression better than did fluoxetine or CBT alone. But when the main outcome measure was function, rather than symptoms of depression, the results were not as robust, he concluded. "The data seem to show that treatment effects on function lag behind those on symptoms."

In the analysis, functional outcomes were measured with the Children's Global Assessment Scale (CGAS), the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q), and the Health of the Nation Outcome Scales for Children and Adolescents (HONOSCA). …